HF 1005

as introduced - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to insurance; amending automobile no-fault 
  1.3             personal injury protection coverage; providing 
  1.4             incentives for prompt billing by health care 
  1.5             providers; reducing insurance fraud; amending 
  1.6             Minnesota Statutes 2002, sections 65B.43, subdivision 
  1.7             9, by adding a subdivision; 65B.44, subdivisions 2, 3, 
  1.8             4; 65B.54, subdivision 2, by adding a subdivision. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 2002, section 65B.43, 
  1.11  subdivision 9, is amended to read: 
  1.12     Subd. 9.  [REPARATION OBLIGOR OR OBLIGOR.] "Reparation 
  1.13  obligor" or "obligor" means an insurer or self-insurer obligated 
  1.14  to provide the benefits required by sections 65B.41 to 65B.71, 
  1.15  including natural persons, firms, partnerships, associations, 
  1.16  corporations, governmental units, trusts and syndicates. 
  1.17     Sec. 2.  Minnesota Statutes 2002, section 65B.43, is 
  1.18  amended by adding a subdivision to read: 
  1.19     Subd. 21.  [MEDICALLY NECESSARY.] "Medically necessary" 
  1.20  means a health care service that is: 
  1.21     (1) consistent with the diagnosis or condition; 
  1.22     (2) provided under the licensed provider's authority under 
  1.23  state law and within the scope of licensure; 
  1.24     (3) clinically appropriate in terms of type, frequency, 
  1.25  extent, level, and duration under the treatment standards 
  1.26  adopted under section 176.83 and workers' compensation; and 
  1.27     (4) rendered:  
  2.1      (i) in response to a life-threatening condition or pain; 
  2.2      (ii) to treat an injury, illness, or infection; 
  2.3      (iii) to treat a condition that could result in physical or 
  2.4   mental disability; or 
  2.5      (iv) to achieve a level of physical or mental function 
  2.6   consistent with prevailing community standards for the diagnosis 
  2.7   or condition. 
  2.8      Sec. 3.  Minnesota Statutes 2002, section 65B.44, 
  2.9   subdivision 2, is amended to read: 
  2.10     Subd. 2.  [MEDICAL EXPENSE BENEFITS.] (a) Medical expense 
  2.11  benefits shall reimburse all reasonable expenses for necessary: 
  2.12     (1) medical, surgical, x-ray, optical, dental, 
  2.13  chiropractic, and rehabilitative services, including prosthetic 
  2.14  devices; 
  2.15     (2) prescription drugs; 
  2.16     (3) ambulance and all other transportation expenses 
  2.17  incurred in traveling to receive other covered medical expense 
  2.18  benefits; 
  2.19     (4) sign interpreting and language translation services, 
  2.20  other than such services provided by a family member of the 
  2.21  patient, related to the receipt of medical, surgical, x-ray, 
  2.22  optical, dental, chiropractic, hospital, extended care, nursing, 
  2.23  and rehabilitative services; and 
  2.24     (5) hospital, extended care, and nursing services.  
  2.25     (b) Hospital room and board benefits may be limited, except 
  2.26  for intensive care facilities, to the regular daily semiprivate 
  2.27  room rates customarily charged by the institution in which the 
  2.28  recipient of benefits is confined.  
  2.29     (c) Such benefits shall also include necessary remedial 
  2.30  treatment and services recognized and permitted under the laws 
  2.31  of this state for an injured person who relies upon spiritual 
  2.32  means through prayer alone for healing in accordance with that 
  2.33  person's religious beliefs.  
  2.34     (d) Medical expense loss includes medical expenses accrued 
  2.35  prior to the death of a person notwithstanding the fact that 
  2.36  benefits are paid or payable to the decedent's survivors.  
  3.1      (e) Medical expense benefits for rehabilitative services 
  3.2   shall be are subject to the provisions of section 65B.45. 
  3.3      (f) A licensed provider lawfully rendering treatment to an 
  3.4   injured person for a bodily injury covered by an obligor under 
  3.5   this section must not charge an unreasonable fee for the 
  3.6   services and supplies rendered and must not charge for services 
  3.7   or supplies that are not medically necessary.  In no event may 
  3.8   any charges be in excess of the amount that the licensed 
  3.9   provider customarily charges for like services or supplies in 
  3.10  cases involving no insurance nor may the charges exceed the 
  3.11  maximum permissible charge under the medical fee schedule 
  3.12  adopted under section 176.136.  Charges that violate this 
  3.13  paragraph are not "reasonable" within the meaning of paragraph 
  3.14  (a). 
  3.15     (g) Obligors may review all bills, invoices, and other 
  3.16  claims for payment submitted by licensed providers to identify 
  3.17  billing errors and charges that are unreasonable or that are for 
  3.18  services or supplies that are not medically necessary.  If an 
  3.19  obligor finds any billing errors or charges that are erroneous, 
  3.20  unreasonable, or not medically necessary, the obligor may 
  3.21  disallow or adjust payment for those services or supplies.  The 
  3.22  obligor is not liable for charges that are unreasonable or in 
  3.23  error, or for services that are not medically necessary.  The 
  3.24  injured party is not liable for, nor shall the provider bill the 
  3.25  injured party for, charges that are unpaid because of the 
  3.26  provider's failure to comply with paragraph (f). 
  3.27     Sec. 4.  Minnesota Statutes 2002, section 65B.44, 
  3.28  subdivision 3, is amended to read: 
  3.29     Subd. 3.  [DISABILITY AND INCOME LOSS BENEFITS.] Disability 
  3.30  and income loss benefits shall provide compensation for 85 
  3.31  percent of the injured person's loss of present and future gross 
  3.32  income from inability to work proximately caused by the nonfatal 
  3.33  injury subject to a maximum of $250 $400 per week.  Loss of 
  3.34  income includes the costs incurred by a self-employed person to 
  3.35  hire substitute employees to perform tasks which are necessary 
  3.36  to maintain the income of the injured person, which are normally 
  4.1   performed by the injured person, and which cannot be performed 
  4.2   because of the injury.  
  4.3      If the injured person is unemployed at the time of injury 
  4.4   and is receiving or is eligible to receive unemployment benefits 
  4.5   under chapter 268, but the injured person loses eligibility for 
  4.6   those benefits because of inability to work caused by the 
  4.7   injury, disability and income loss benefits shall provide 
  4.8   compensation for the lost benefits in an amount equal to the 
  4.9   unemployment benefits which otherwise would have been payable, 
  4.10  subject to a maximum of $250 $400 per week.  
  4.11     Compensation under this subdivision shall be reduced by any 
  4.12  income from substitute work actually performed by the injured 
  4.13  person or by income the injured person would have earned in 
  4.14  available appropriate substitute work which the injured person 
  4.15  was capable of performing but unreasonably failed to undertake. 
  4.16     For the purposes of this section "inability to work" means 
  4.17  disability which prevents the injured person from engaging in 
  4.18  any substantial gainful occupation or employment on a regular 
  4.19  basis, for wage or profit, for which the injured person is or 
  4.20  may by training become reasonably qualified.  If the injured 
  4.21  person returns to employment and is unable by reason of the 
  4.22  injury to work continuously, compensation for lost income shall 
  4.23  be reduced by the income received while the injured person is 
  4.24  actually able to work.  The weekly maximums may not be prorated 
  4.25  to arrive at a daily maximum, even if the injured person does 
  4.26  not incur loss of income for a full week.  
  4.27     For the purposes of this section, an injured person who is 
  4.28  "unable by reason of the injury to work continuously" includes, 
  4.29  but is not limited to, a person who misses time from work, 
  4.30  including reasonable travel time, and loses income, vacation, or 
  4.31  sick leave benefits, to obtain medical treatment for an injury 
  4.32  arising out of the maintenance or use of a motor vehicle. 
  4.33     Sec. 5.  Minnesota Statutes 2002, section 65B.44, 
  4.34  subdivision 4, is amended to read: 
  4.35     Subd. 4.  [FUNERAL AND BURIAL EXPENSES.] Funeral and burial 
  4.36  benefits shall be reasonable expenses not in excess of 
  5.1   $2,000 $5,000, including expenses for cremation or delivery 
  5.2   under the Uniform Anatomical Gift Act (1987), sections 525.921 
  5.3   to 525.9224. 
  5.4      Sec. 6.  Minnesota Statutes 2002, section 65B.54, 
  5.5   subdivision 2, is amended to read: 
  5.6      Subd. 2.  Overdue payments shall bear simple interest at 
  5.7   the rate of 15 percent per annum.  The amount of interest 
  5.8   accrued on an overdue payment, if any, may be included in the 
  5.9   benefits payment. 
  5.10     Sec. 7.  Minnesota Statutes 2002, section 65B.54, is 
  5.11  amended by adding a subdivision to read: 
  5.12     Subd. 6.  [PROMPT BILLING REQUIRED.] (a) With respect to 
  5.13  any treatment or service, other than medical services billed by 
  5.14  a hospital for services rendered at a hospital-owned facility, 
  5.15  the statement of charges must be furnished to the obligor by the 
  5.16  provider and must not include, and the insurer is not required 
  5.17  to pay, charges for treatment or services rendered more than 30 
  5.18  days before the postmark date of the statement.  Obligors may 
  5.19  require providers to submit additional documentation to support 
  5.20  the statement of charges if the additional documentation is 
  5.21  relevant to the treatment for which payment is sought.  If the 
  5.22  obligor requests that the additional documentation be submitted 
  5.23  along with the statement of charges, the 30-day time period does 
  5.24  not begin to run until the additional documentation is 
  5.25  provided.  The 30-day time period does not apply to past due 
  5.26  amounts previously billed on a timely basis under this 
  5.27  paragraph.  If the provider submits to the obligor a notice of 
  5.28  initiation of treatment within 21 days after the provider's 
  5.29  first examination or treatment of the injured person, the 
  5.30  statement may include charges for treatment or services rendered 
  5.31  up to, but not more than, 60 days before the postmark date of 
  5.32  the statement.  The injured party is not liable for, and the 
  5.33  provider shall not bill the injured party for, any charges that 
  5.34  are unpaid because of the provider's failure to comply with this 
  5.35  paragraph.  Any agreement requiring the injured person or 
  5.36  insured to pay for such charges is unenforceable.  Submitting 
  6.1   the statement of charges to the injured party's attorney does 
  6.2   not relieve the provider of the obligation to comply with this 
  6.3   subdivision nor does that submission affect the 30-day time 
  6.4   period. 
  6.5      (b) For emergency services and care rendered in a hospital 
  6.6   emergency department or for transport and treatment rendered by 
  6.7   an ambulance provider, the provider is not required to furnish 
  6.8   the statement of charges within time periods established by this 
  6.9   paragraph and the insurer shall not be considered to have been 
  6.10  furnished with notice of the amount covered until it receives a 
  6.11  statement which specifically identifies the place of service to 
  6.12  be a hospital emergency department or an ambulance in accordance 
  6.13  with the billing standards recognized by the federal Centers for 
  6.14  Medicare and Medicaid Services. 
  6.15     Sec. 8.  [EFFECTIVE DATE.] 
  6.16     Sections 1 to 7 are effective January 1, 2004, and apply to 
  6.17  policies issued or renewed on or after that date.